Objective(s): There is an active debate as to the optimal method of Fontan palliation. In light of this debate we reviewed our experience with the extracardiac Fontan including Fontan conversion.Methods: Retrospective review was performed of all initial completion Fontan and Fontan conversion operations at our institution from 7/1996 to 12/31/2018. Standard demographic data were collected as well as operative details, perioperative data, and clinical outcomes.Results: There were 351 patients with an overall operative mortality of 1.1%. Of these, 203 patients (57.8%) were Fontan completion operations and 148 patients (42.2%) were Fontan conversions. The Fontan completion patients had a mean age of 4.6±5.3 years and the Fontan conversion patients had a mean age of 24.1±8.7 years. Length-of-stay was 14.86±13.91 days with ventilator duration of 1.21±1.93 days. Six of the completion Fontan patients (4%) required Fontan take down at a median time of 2.5 days. Thirteen of the completion Fontan patients (6%) have required late cardiac transplantation. Six (4.1%) of the Fontan conversion patients required transplant within one year, while another 6 (4.1%) required late cardiac transplantation.Conclusions: Over the past 23 years our strategy of non-fenestrated extracardiac Fontan has achieved a low operative mortality for both initial Fontan and Fontan conversion. There is a steady attrition of Fontan patients to cardiac transplantation, more so in the Fontan conversion group as compared to the Fontan completion group.